Angry Doctor

Saturday, April 07, 2007

Confidence Goods 8

angry doc doesn't usually feature articles from The New Paper, but he would like to use this one as material for our exercise this weekend:

Health expert says: It won't work for specialist clinics
By Ng Wan Ching
April 05, 2007

APPLYING economic laws to healthcare products and services is tricky.

And consumer ignorance is one reason why market forces may not 'work to the full extent' when it comes to the cost of specialist care.

Health economist Phua Kai Hong, of the National University of Singapore, said this in response to the Singapore Medical Association's (SMA) statement that it will no longer issue guidelines on fees.

The association said the guidelines on fees may go against the Competition Act, which came into effect last January.

Recommending charges could be considered price-fixing and breaking the law.

On this issue, Associate Professor Phua, who was involved with the SMA in the past to revise the guidelines, said: 'The worry is not so much for primary healthcare. The GPs are already very competitive.

'With specialists, there is usually more consumer ignorance. This is where market forces cannot work to the full extent,' he said.

By the time patients need to see specialists, it may be an emergency or they are quite ill and may be psychologically affected. By then, few will seek a second or third opinion.

'(An unethical doctor) may decide to do a wallet biopsy to see how much the patient can afford. How many patients will know enough to make rational and cost-effective choices?' Assoc Prof Phua asked.

(Wallet biopsy is medical lingo to describe a check on a patient's financial ability to pay for medical services.)

Which is why he does not understand why the Competition Act should have any impact on the guidelines.

He said the guidelines were developed by comparing local fees here against the fee schedules of other developed countries as a fair and rational means of paying doctors.

'Healthcare is a special economic product. It has humanitarian and moral characteristics. It's very personal,' he said.

Assoc Prof Phua, who also chaired a past Health Ministry-related committee on Transparency in Hospital Billing in 2004, said there will be issues too if the doctor is not cost-conscious.

'He is in a position to order all sorts of tests and if the consumer is ignorant, it is very hard to challenge which tests are necessary and which are not,' he said.


He explained that the guidelines were there for reference on what was fair - a range of fees from the low end to the high end - but it was not something that had to be followed.

'In the US and almost all developed countries, that's how they do it. Every procedure has a fee guideline. Without it, there is no check and balance,' he said.

The problem, he added, is also compounded by the lack of comprehensive information on average bill sizes for private hospitals - they have given their bill sizes voluntarily and the list is not complete. Bill sizes also do not reflect doctors' fees, he pointed out.

A Health Ministry spokesman said that it is still working on getting more bill-size information from private hospitals for its website.

Associate Professor Goh Lee Gan, a past president of the SMA, said that individual doctors should now display their own GOF (guideline of fees).

'The patient can still ask the doctor what his fees will be, roughly. It's likely that life will go on as usual,' he said.

If a doctor overcharges, even if he is a specialist, word will get around and patients will leave.

He added: 'It is important to teach patients to find out what they are paying for and whether they get what they are paying for.'

For this, the press definitely has a role to play, Assoc Prof Goh said.

MOH said its guidelines under the Private Hospitals and Medical Clinics Act and Regulations still stand.

Before consultation, doctors are encouraged to inform patients on the likely charges. Every private hospital manager is required by law to ensure that every patient is informed, on or before his admission, of the estimated total charges for his hospitalisation and treatment.

This is to allow patient and family to make informed choices.

The Competition Commission of Singapore (CCS), which is the competition watchdog here, has welcomed the move by the SMA to remove its guidelines.

A CCS spokesman said this would permit greater flexibility for fees to be set by doctors in line with their business costs.

Such a move is more in line with today's circumstances.

Consumers would therefore benefit from the greater transparency and competition of prices.

Now count how many times the word 'quality' appears in the article.



  • I think the minister is more concerned about cost-effectiveness rather than quality. As for the public, if there is consumer ignorance as this article suggests, they won't be the wiser.

    How many breast cancer patients would know enough to ask about Herceptin and apart from the Prime Minister, how many fellow patients with lymphoma would have heard of Rituxmab?

    How do you estimate the charges then? Do you mention to a breast cancer patient that treatment may include a various lab tests, a FISH assay for Her2 amplificatrion and treatment with Herceptin? The inclusion of state-of-the-art treatment can easily triple your estimate.

    If you reveal all, an undercover reporter may report in the press that you are over-charging. If you only mention the cheapest mode of treatment, you have done your patient a disservice by not revealing to her the best options available.

    As for MOH, the minister would rather you keep expensive investigations and treatment to yourself but will publicly declare that doctors have to provide the best treatment available to their patients.

    By Anonymous Anonymous, At April 08, 2007 1:53 am  

  • It is really up to us to speak to the patient (nicely) and educate them. When they read data, they may read it very subjectively and may also take some evidence point blank without considering its validity in the patient's context.

    I won't be surprised if someone reads about R-CHOP and on generic substitution and ask for generic Mabthera and Adriamycin @@ >.<

    By Blogger OJ - Da UNlicensed Pharmacist, At April 08, 2007 7:41 pm  

  • Hah! good crack on the PM there. Healthcare has always been quite a big debate in SG; wonder if it's because of the displaced minister, being from a northern neighbour, has no real ideas of his own.

    Anyway, this can allow doctors to earn more money can't it? So why bitch about it.

    In another 'news paper' article, it was said that the top 6 private sector earners don't include doctors.

    For heaven's sake: doctors study the hardest, work the hardest, face all sorts of dangers in their work place (MRSA, VISA, radiation). How can that damn accountant earn more than doctors?

    I think it's time that doctors all around the world unite and make sure healthcare is reasonable to doctors first, then patients.

    How else will you improve quality without that small monetary incentive? Am I right Mr. Ministers? PM? anyone?

    By Anonymous Anonymous, At April 12, 2007 6:54 pm  

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